The Roma people have been in Europe for nearly a thousand years. During that time they have suffered discrimination, oppression and, during World War II, the extermination of half a million Roma in the Nazi death camps. While social and economic realities faced by the Roma have been examined by bureaucracies and academics, the health challenges and inequities experienced in their communities have remained under-researched.
From what little research does exist, we can see that the Roma seem to suffer from increased morbidity from non-communicable diseases (NCDs) and that they have poorer access to health services and uptake of preventative care. In one study that took place in Ghent, Belgium, researchers found that the Roma population had a number of barriers to care such as financial constraints, mobility issues and not knowing the language. They also have a lack of trust in care providers, which tends to make attempts to get care emergency-only situations.
While it is true that nomadic pastoralists and other mobile groups such as migratory workers and refugees live beyond the reach of established healthcare programmes that serve sedentary communities, groups like the Roma do tend to tread the same ground from year-to-year. Healthcare facilities should therefore not be difficult for them to get to. For other nomadic peoples, using methods from epidemiology, geographic information systems, and anthropology, solutions can be devised to improve service provision to these difficult to reach populations – as has been done in East Africa. There, it was found that Nomadic populations living within a general area can be made more open to modern health care once the barriers are lessened. This includes convincing them that the healthcare system is not being used as an instrument to control them, but as something to help them.
It is not just a general lack off accessibility to the healthcare system that is hindering the health of the Roma people – there is now evidence that the Roma are increasingly likely to suffer from NCDs.
In Europe, the cost of NCDs annually is as high as €700 billion for national healthcare systems, and premature death from NCDs create a loss of 0.8% in the European Union (EU) GDP per year. There is also strong evidence that the most vulnerable suffer the most. NCDs have been shown to affect those in the low-income and middle- income socio-economic strata.
As the largest European ethnic minority, and one that is considered a vulnerable group, the Roma’s health is inexorably linked to the social determinants of health such as poverty, social exclusion, and anti-gypsyism. The Roma’s overall life expectancy is between five and 20 years lower than the non-Roma population in the same country. Though the information on the life expectancy and mortality for the Roma community within Europe is disjointed and ad-hoc, there is a strong indication that their infant mortality rate is significantly higher, they live below the national income poverty threshold and that half of Roma between 6 and 24 years of age do not attend school .
At the EU level, political leaders have been working with Roma to try to improve their quality of life, however real change has yet to be seen. The levels of discrimination that are faced by the Roma in the healthcare systems throughout Eastern and Western Europe are matched by the discrimination that they are faced with in schools and in other institutional bodies. The cost to governments, healthcare systems and communities will continue to be high, as the birth rates are high and the mortality rates are twice or three times higher compared to the general population. This is while most European countries are concerned with their aging populations.
Solutions, while challenging, are available and have been shown to work in other contexts. When it comes to looking at NCDs, early diagnosis, improved access to quality and affordable treatment and education on tobacco and alcohol use, physical inactivity and unhealthy diet along with how to deal with high blood pressure, high levels of cholesterol, high sugar intake and obesity could change the outlook of the community. In East Africa, monitoring and follow-up was set up in a way that was convenient though less strict than for those within sedentary communities. Trust can be built through better education for men and women, within and between countries.